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Washington University Experience | NEURODEGENERATION | Aging-Related Astroglial Tauopathy (ARTAG) | 4A0 Case 4 History
Case 4 History ---- The patient was an 87yo female with a history of Alzheimer's dementia, rheumatoid arthritis, hypothyroidism, anxiety, and depression who presented to the Emergency Department in 09/2018 with altered mental status and failure to thrive. At that time, she was found to be severely hypernatremic and dehydrated. She was started on IVF and had mild improvement in her sodium level but her overall mental status remained unchanged. Because of her worsening mental status and end-stage dementia, her family decided to discharge her to a nursing facility with hospice care in 09/2018. Per report, the patient did not improve and she remained non-verbal, bedbound, and nonresponsive to external stimuli until her death in late 2018. ---- At autopsy the weight of the unfixed brain was 960g. She had Alzheimer disease neuropathologic change using NIA-AA criteria (ADNC high, A3B3C2). This patient also had numerous Lewy bodies and neurites in a pattern consistent with dementia with Lewy bodies. A third pathologic process in this patient is the presence of significant numbers of granular and filamentous TDP43 immunoreactive inclusions in the mesial temporal cortex, often designated TDP43 proteinopathy. TDP43 proteinopathy is not uncommon in patients with other severe neurodegenerative diseases such as Alzheimer disease. Its pathogenetic role in this case is unestablished.
